5 Picks for 5 August 2011

On the 5th, 15th and/or 25th of each month, we post 5 “picks” selected by researchers, physicians, policymakers, other professionals, patients, advocates and caregivers. These picks represent articles, books, websites, films, etc. that they have chosen as particularly interesting, compelling or descriptive of science — either in general or in an area in which they have an active interest.

Today’s installment follows a slightly different format. Following are five articles from Nature Publishing Group publications that may be relevant to readers interested in CFS. They came up in a search of articles I conducted for this week’s blog post, “Nature’s Call: CFS Through the Pages of Nature Publishing Group.” There were numerous articles that could have been included in this list, so I limited the final selections to recent open-access articles that reviewed other literature and that were (relatively speaking) easy-to-read. The picks are presented in chronological order.

We’ll return to the usual format on August 15 with picks from some of the researchers who have recently published studies about CFS.

Summary: Researchers have proposed bacterial and viral triggers for many other chronic diseases, such as cancers and coronary heart disease. Marshall and Warren’s famous experiment with Helicobacter pylori proved that a bacteria caused a chronic disease that had previously been attributed to genetic and lifestyle factors. It had far wider implications than curing a single disease. “Human microecology is changing, and these changes have manifestations in terms of disease,” said Martin Blaser, Chair of the Department of Medicine at New York University. To understand the impact of these changes, researchers need to take a closer look at host–pathogen interactions—both good and bad.

Summary: All organisms must maintain a complex dynamic equilibrium, or homeostasis, which is constantly challenged by internal or external adverse forces termed stressors. Stress occurs when homeostasis is threatened or perceived to be so; homeostasis is re-established by various physiological and behavioral adaptive responses. Neuroendocrine hormones have major roles in the regulation of both basal homeostasis and responses to threats, and are involved in the pathogenesis of diseases characterized by dyshomeostasis or cacostasis. The stress response is mediated by the stress system, partly located in the central nervous system and partly in peripheral organs. Malfunction of the stress system might impair growth, development, behavior and metabolism, which potentially lead to various acute and chronic disorders.

Summary: In a recent issue of The Journal of Pain, Hauser et al. performed a meta-analysis of published trials of the three drugs approved in the USA for use in fibromyalgia: duloxetine, milnacipran and pregabalin. Eleven randomized controlled trials including a total of 6,388 patients met the inclusion criteria and were included in the review. Outcomes of interest were improvements in pain, fatigue, sleep disturbance, depressed mood and health-related quality of life, as well as adverse events.

Summary: Irritable bowel syndrome (IBS) is a common gastrointestinal condition characterized by chronic or recurrent abdominal pain associated with altered bowel habits. IBS is considered a functional bowel disorder (that is, not defined by structural or biochemical abnormalities) and is diagnosed using symptom-based criteria. Limited and judicious use of diagnostic testing is recommended, particularly in patients with typical symptoms of IBS without alarm signs and symptoms. Management of IBS is based on a multifactorial approach and includes establishment of an effective patient–provider relationship, education, reassurance, dietary alterations, pharmacotherapy, behavioral and psychological treatment. Patient-centered care is recommended, in which management is focused on the patient’s most bothersome and impactful symptoms, their preferences and previous experiences with treatment, and addressing factors associated with the onset and exacerbation of symptoms. Pharmacotherapy is typically targeted against the predominant symptom. This Review discusses the current evidence-based recommendations for the diagnosis and management of IBS. An improved understanding of the recommended diagnostic and therapeutic approaches for IBS will lead to greater patient satisfaction, as well as reduced health-care costs.

Summary: Pain as an acute, warning symptom is essential: it saves lives. By contrast, chronic pain—pain that persists indefinitely beyond the resolution of the initiating injury—is maladaptive. Approximately 20% of the adult population in the Western world are thought to have a chronic pain disorder; however, treatment strategies for chronic pain are lacking and, consequently, many patients have to live with unbearable pain. As a result, chronic pain is associated with appreciable health-care and socioeconomic costs. Measurable markers of the pain state could aid the development of drug treatments for both acute and chronic pain, but the identification of such markers that are trusted by medical, legislative and approval bodies is a major challenge.

Another frontier development in the pain field has been the realization that both normal acute pain and the progression to a chronic pain state following injury, infection or disease have genetic bases. Our understanding of the genetic complexity of pain increases each year. Nevertheless, a need still exists for measures such as endophenotypes that might reflect, in a simplified manner, the outcomes of the complex genetic bases underpinning acute and chronic pain as well as how the environment influences these genes as we develop into adults. Neuroimaging studies could potentially identify such endophenotypes. This Review provides an overview of the neuroimaging literature relevant to the pain field and highlights possible pain endophenotypes that future studies could further explore.

Summary: The severity of fatigue in patients with chronic hepatitis C (CHC) may be linked to plasma carnitine levels, according to a new French study by Roldolphe Anty and colleagues. Oral supplementation with carnitine may, therefore, be an effective way to relieve fatigue in such patients.